Background: Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. Purpose: To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. Study Type: Prospective, crossover. Population: Twenty-eight subjects (54 AE 13 years; 17 female). Field Strength/Sequence: 1.5 T; three-dimensional (3D) gradient recalled echo. Assessment: Quantitative image quality was measured by normalized signal intensity (SI n ) [SI n = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence). Statistical Tests: SI n and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test. Results: No significant difference in SI n was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 AE 2.5 vs. 4.8 AE 1), left internal carotid (7.3 AE 2 vs. 4.4 AE 1.2), right internal carotid (7.7 AE 2.2 vs. 5 AE 1.1), and left vertebral (6.6 AE 2.2 vs. 4.5 AE 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SI n s. GM showed significantly higher artifact than GB (3.56 AE 0.52 vs. 3.36 AE 0.46) and significantly lower overall image quality (10.73 AE 1.45 vs. 11.26 AE 1.58) at the left vertebral artery. Data Conclusion: At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. Level of Evidence: 2 Technical Efficacy: Stage 2

The purpose of the study was to determine the level of access that youths in child welfare have to mental health providers in a single state. Mystery shoppers called every provider publicly advertised in Medicaid managed care organization networks. Results showed that 25.4% of the advertised network was able to schedule a new appointment for a child in Department of Children and Family Services guardianship. There were 9.7 accessible providers of any discipline (MD, PhD, or licensed masters-level clinician) per 10,000 Medicaid-enrolled youths in the population. The level of access to MDs was 4.1 times lower than the nationallyrecommended level.

Introduction: Diffuse myocardial fibrosis plays a key role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Cardiac magnetic resonance (CMR) parameters such as native myocardial T1 relaxation time and extracellular volume fraction (ECV) are evolving imaging-based biomarkers of myocardial fibrosis. Therefore, we performed a systematic review to synthesize the available data on the prognostic value of T1 and ECV in patients with HFpEF. Methods and Results:We searched PubMed, Embase and Cochrane Central for relevant studies using predefined search criteria and endpoints. Studies with overlapping patient population were excluded. Four studies were included in the review (TABLE). All included studies were prospective, single-center observational cohorts. Of the 1507 participants, 62% were women, mean age was 74.7 § 8.3 years, and mean left ventricular EF was 63.2 § 9.3%. Two of the 4 studies reported outcomes in relation to native T1 value. Both of them found no significant association of T1 value with adverse cardiovascular outcomes. One study found that lower post contrast T1 times were significantly associated with adverse cardiac events (HR-0.99; 95% CI-0.98-0.99). Three studies reported outcomes in relation to ECV and all of them found that higher ECV was associated with increased risk for adverse cardiovascular events or mortality. Two of the studies also assessed histological ECV (by endomyocardial biopsy) and demonstrated strong correlation between histologically determined ECV and CMR quantification of ECV (R=0.494; P=0.037). Conclusion: Estimation of ECV may provide important prognostic information in patients with HFpEF and has the potential to improve risk stratification.